Literature Evaluation Table

Criteria

Article 1

Article 2

Article 3

Article 4

Author, Journal (Peer-Reviewed), and

Permalink or Working Link to Access Article

Article Title and Year Published

Research Questions (Qualitative)/Hypothesis (Quantitative)

Purposes/Aim of Study

Design (Type of Quantitative, or Type of Qualitative)

Setting/Sample

Methods: Intervention/Instruments

Analysis

Key Findings

Recommendations

Explanation of How the Article Supports EBP/Capstone Project

Article 5

Article 6

Article 7

Article 8

Research Questions (Qualitative)/Hypothesis (Quantitative)

Purposes/Aim of Study

Explanation of How the Article Supports EBP/Capstone

Criteria

Article 1

Article 2

Article 3

Article 4

Author, Journal (Peer-Reviewed), and

Permalink or Working Link to Access Article

Atkins, L., Sallis, A., Chadborn, T., Shaw, K., Schneider, A., Hopkins, S., Bunten, A., Michie, S., & Lorencatto, F. (2020). Reducing catheter-associated urinary tract infections: a systematic review of barriers and facilitators and strategic behavioral analysis of interventions. Implementation Science : IS, 15(1), 44. https://doi-org.lopes.idm.oclc.org/10.1186/s13012-020-01001-2

Bagchi, S., Watkins, J., Norrick, B., Scalise, E., Pollock, D. A., & Allen-Bridson, K. (2020). Accuracy of catheter-associated urinary tract infections reported to the National Healthcare Safety Network, January 2010 through July 2018. American Journal of Infection Control, 48(2), 207–211. https://doi-org.lopes.idm.oclc.org/10.1016/j.ajic.2019.06.006

Balu, P., Ravikumar, D., Somasunder, V. M., Suga, S. S. D., Sivagananam, P., Jeyasheelan, V. P., Sreekandan, R. N., James, K. M., Bopaiah, S. K., Chelladurai, U. M., Kumar, M. R., Chellapandian, P., Sundharesan, N., Krishnan, M., Kunasekaran, V., Kumaravel, K., Manickaraj, R. G. J., Veeraraghvan, V. P., & Mohan, S. K.

(2021).

Assessment of Knowledge, Attitude and Practice on Prevention of Catheter-associated Urinary Tract Infection (CAUTI) among Health Care Professionals Working in a Tertiary Care Teaching Hospital. Journal of Pure and Applied Microbiology, 15(1), 335. https://doi-org.lopes.idm.oclc.org/10.22207/JPAM.15.L28

Childers, C., Edsall, C., Gannon, J., Whittington, A. R., Muelenaer, A. A., Rao, J., & Vlaisavljevich, E. (2021).

Focused Ultrasound Biofilm Ablation: Investigation of Histotripsy for the Treatment of Catheter-Associated Urinary Tract Infections (CAUTIs). 

IEEE Transactions on Ultrasonics, Ferroelectrics, and Frequency Control, Ultrasonics, Ferroelectrics, and Frequency Control, IEEE Transactions on, IEEE Trans. Ultrason., Ferroelect., Freq. Contr, 68(9), 2965–2980. https://doi-org.lopes.idm.oclc.org/10.1109/TUFFC.2021.3077704

Article Title and Year Published

Reducing catheter-associated urinary tract infections: a systematic review of barriers and facilitators and strategic behavioral analysis of interventions. (2020)

Accuracy of catheter-associated urinary tract infections reported to the National Healthcare Safety Network, January 2010 through July 2018. (2020)

Assessment of Knowledge, Attitude and Practice on Prevention of Catheter-associated Urinary Tract Infection (CAUTI) among Health Care Professionals Working in a Tertiary Care Teaching Hospital. (2021).

Research Questions (

Qualitative

)/Hypothesis (

Quantitative

)

Will introducing an indwelling catheter management checklist before catheter use decrease CAUTI development and improve nursing quality of care for patients?

Implementing an interactive CAUTI prevention educational program enhance the nurse’s knowledge and prevent under reporting?

Implementing an interactive CAUTI prevention educational program enhance the nurse’s knowledge on the appropriate use of the indwelling urinary catheter and reduce the incidence of CAUTI’s?

Will this biofilm ablation be effective for histotripsy to be utilized for the treatment of CAUTIs?

Purposes/Aim of Study

Improving infection prevention and control

Underreporting of catheter-associated urinary tract infections (CAUTI) is a major concern

The purpose of the current research was to find out the level of knowledge, attitude and practice on prevention of CAUTI among healthcare professionals working in tertiary care hospital.

To provide a new modality for removing bacterial biofilms from catheter-based medical devices and suggest that additional work is warranted to investigate histotripsy for the treatment of CAUTIs and other biomaterial-associated infections.

Design (Type of

Quantitative,

or Type of Qualitative)

Mixed Methods,

Qualitative,

Quantitative,

Non- Randomized.

Setting/Sample

District nurses (101/129 total sample; 18 community hospital and 10 nursing home care staff)

infection control nurse (42), nurse/nurse manager (25), other, e.g. quality manager (2), hospital epidemiologist or infectious diseases physician (1); prevention specialists

patients (183), nurses (107)

Male in-patients with acute indwelling urinary catheters; staff of the medical center

The impact of 2015 CAUTI definition changes were tested by comparing pooled accuracy estimates of validations prior to 2015 with post-2015.

95 health care working in tertiary care hospital in Chennai.

An eight-element, 1-MHz histotripsy transducer with a geometric focus of 36 mm, an aperture of 5.27 mm, and an f -number of.68 was used for all experiments in this study.

Methods: Intervention/Instruments

A mixed-methods, three-phased study: (1) systematic review of 25 studies to identify (i) behaviors relevant to CAUTI and (ii) barriers to and facilitators of CAUTI-related behaviors, classified using the COM-B model and Theoretical Domains Framework (TDF); (2) content analysis of nationally adopted CAUTI interventions in England identified through stakeholder consultation, classified using the Behavior Change Wheel (BCW) and Behavior Change Techniques Taxonomy (BCTTv1); and (3) findings from 1 and 2 were linked using matrices linking COM-B and TDF to BCW/BCTTv1 in order to signpost to intervention design and refinement.

Data accuracy measures included pooled mean sensitivity, specificity, positive predictive value, and negative predictive value. Total CAUTI error rate was computed as proportion of mismatches among total records. The impact of 2015 CAUTI definition changes were tested by comparing pooled accuracy estimates of validations prior to 2015 with post-2015.

The demographic data section, it consists of details of the participants such as age, gender, education, profession, and professional experience. This was followed by a set of 14, yes or no questions to assess the level of knowledge

High-speed optical imaging and real-time B-mode ultrasound imaging were used to capture cavitation activity and monitor histotripsy treatments. Coaxial ultrasound imaging probe inside the histotripsy therapy transducer and a high-speed optical camera positioned at 90° from each other, are shown in Fig. 1(A). Optical imaging was performed using a high-speed camera (Blackfly S monochrome, FLIR Integrated Imaging Solutions, Richmond, BC, Canada) and a 100-mm F2.8 Macro lens (Tokina AT-X Pro, Kenko Tokina, Tokyo, Japan). This setup resulted in captured images with a resolution of 3.25 μm per pixel.

Analysis

This analysis applied a matrix that included the BCT × TDF pairings published in Cane et al. and Michie et al.to investigate the level of theoretical congruence between the content of interventions targeting CAUTI and the published literature on factors influencing behaviors related to CAUTI

Catheter-associated urinary tract infections (CAUTIs) are a cause of increased morbidity, mortality, length of stay, and hospital costs, and, by some estimates, account for >30% of all health care–associated infections

A validated structured questionnaire on knowledge and modified Likert scaled attitude, and practice questionnaire were given to the participants for assessment. It was framed by following the review of literatures, national, and international CDC guidelines. The questionnaire was validated by following face validity method. The validity and reliability of the tool were tested by conducting a pilot study in different group of participants working in tertiary care hospital. 

N/A

Key Findings

: Interventions incorporated half the potentially relevant content to target identified barriers to and facilitators of CAUTI-related behaviors. There were missed opportunities for intervention as most focus on shaping knowledge rather than addressing motivational, social and environmental influences. This study suggests that targeting motivational, social and environmental influences may lead to more effective intervention design and refinement.

CAUTI underreporting is a major concern; validations provide transparency, education, and relationship building to improve reporting accuracy.

The Sample size was small, as many participants were not be able to include in the study due to the COVID-19 pandemic, hence a large sample size be required in order to generalize these results to the whole population.

The ability to generate well-confined bubble clouds in the lumen of catheters without inducing unwanted cavitation on the external surface of the catheter, which was demonstrated in the first part of this study, will be essential for histotripsy to be utilized for the treatment of CAUTIs.

 This resolution is expected to be sufficient for capturing histotripsy cavitation bubbles, but may not capture smaller cavitation events isolated to the luminal wall, as has been mentioned in previous studies of intrinsic threshold histotripsy that have used similar methods 

Recommendations

The interventions identified in this work used a narrow range of strategies—primarily educational and often delivered in the form of guidelines. To better address barriers and facilitators identified in the systematic review, more proactive strategies are needed to increase the implementation of these guidelines [45]. Strategies could include effective communication to target audiences when guidelines are published across all settings; clear summary documents with key messages; implementation plans to facilitate the translation of recommendations into practice.

At least 19 state health departments conducted CAUTI validations and indicated pooled mean sensitivity of 88.3%, specificity of 98.8%, positive predictive value of 93.6%, and negative predictive value of 97.6% of CAUTI reporting to the National Healthcare Safety Network. Among CAUTIs misclassified (121), 66% were underreported and 34% were over reported. CAUTI classification error rate declined significantly from 4.3% (pre-2015) to 2.4% (post-2015). Reasons for CAUTI misclassifications included: misapplication of CAUTI definition, misapplication of general health care-associated infection definitions, and clinical judgment over surveillance definition

Infection prevention programs in every hospital must develop, implement, and monitor policies and procedures to minimize infections associated with the use of urinary catheters. In the health care setups, there must be medical education programs, interdisciplinary training programs, and audits to be conducted with checklist about catheter care to improve the knowledge and practice of health care professionals.

The feasibility of using histotripsy for the treatment and prevention of CAUTIs. The finding that histotripsy can noninvasively remove bacterial biofilms and kill the associated bacteria cells suggests that future studies are warranted to develop histotripsy as a noninvasive ablation method for the treatment of CAUTIs as well as the many other catheter-based medical devices that are prone to infection.

Explanation of How the Article Supports EBP/Capstone Project

It gives an idea on how to implement a program to nurses and how well it will work on reducing the CAUTI’S.

It focuses on the proper accurate reporting for appropriate catheter use, and how reduction of catheter days reduces CAUTI cases

Assesses the essence of surveillance in reducing cases as well as severity of CAUTI.

Article 5

Article 6

Article 7

Article 8

Landerfelt, P. E., Lewis, A., Li, Y., & Cimiotti, J. P. (2020). Nursing leadership and the reduction of catheter-associated urinary tract infection. American Journal of Infection Control, 48(12), 1546–1548. https://doi-org.lopes.idm.oclc.org/10.1016/j.ajic.2020.07.018

Snyder, R. L., White, K. A., Glowicz, J. B., Novosad, S. A., Soda, E. A., Hsu, S., Kuhar, D. T., & Cochran, R. L. (2021). Gaps in infection prevention practices for catheter-associated urinary tract infections and central line-associated bloodstream infections as identified by the Targeted Assessment for Prevention Strategy. American Journal of Infection Control, 49(7), 874–878. https://doi-org.lopes.idm.oclc.org/10.1016/j.ajic.2021.01.014

Nazarko, L. (2020). Catheter-associated urinary tract infections in the community. British Journal of Community Nursing, 25(4), 188–192. https://doi-org.lopes.idm.oclc.org/10.12968/bjcn.2020.25.4.188

Zhong, X., Xiao, L.-H., Wang, D.-L., Yang, S.-W., Mo, L.-F., He, L.-F., Wu, Q.-F., Chen, Y.-W., & Luo, X.-F. (2020). Impact of a quality control circle on the incidence of catheter-associated urinary tract infection: An interrupted time series analysis. American Journal of Infection Control, 48(10), 1184–1188. https://doi-org.lopes.idm.oclc.org/10.1016/j.ajic.2020.01.006

Nursing leadership and the reduction of catheter-associated urinary tract infection. (2020).

Gaps in infection prevention practices for catheter-associated urinary tract infections and central line-associated bloodstream infections as identified by the Targeted Assessment for Prevention Strategy. (2021).

Catheter-associated urinary tract infections in the community. (2020).

Impact of a quality control circle on the incidence of catheter-associated urinary tract infection: An interrupted time series analysis. (2020).

Research Questions (Qualitative)/Hypothesis (Quantitative)

By enhancing nursing knowledge in catheter associated urinary tract infection, this will prevent infections with proper strategies for care and protocol to decrease the development of CAUTI’s.

Can preventing healthcare associated diseases significantly enhance patient safety?

The purpose of this study was to determine if specific features of nursing leadership are associated with catheter-associated urinary tract infection (CAUTI).

The goal of this evaluation was to describe reported gaps in infection prevention practices for CAUTI and CLABSI in acute care hospital settings, as identified by responses to the CAUTI and CLABSI TAP Facility Assessments.

This article examines the clinical indications for indwelling urinary catheterization and the diagnosis and treatment of catheter-associated urinary tract infections (CAUTI). 

 To find the root causes of the high incidence of CAUTI through the QCC activities in our hospital. Moreover, the countermeasures are developed to deal with the causes

Our population of interest was registered nurses who provided direct patient care. All full-time and part-time nurses who spent at least 80% of their work time providing direct patient care were invited to participate. Registered nurses who were not direct care providers and advanced practice nurses were excluded from the study. Nurse participants represented 41 units in 5 academic, acute care hospitals. Four of the study sites were recognized as Magnet hospitals; those known for excellence in nursing care. A total of 441/1,371 nurses completed and submitted a survey (response rate 32%) and 158 nurse responses were eliminated due to insufficient hospital and unit identifiers.

The Centers for Disease Control and Prevention (CDC) created the Targeted Assessment for Prevention (TAP) Strategy as a quality improvement framework. The TAP Strategy consists of TAP Reports, TAP Facility Assessments, and the use of TAP Implementation Guides. TAP Reports are generated within the Patient Safety Component of the National Healthcare Safety Network, the largest HAI surveillance system in the United States with over 25,000 facilities reporting data. The reports are designed to identify facilities and units with excess HAIs using the cumulative attributable difference (CAD) metric, which has been previously described in detail. TAP Facility Assessments may then be used to identify perceived gaps in knowledge, awareness, and adherence to infection prevention practices by surveying staff across multiple roles within the facility or unit. Infection prevention improvements can then be made by accessing prevention resources within the CDC.

A UK study extrapolated data from the south and west of England of people who had indwelling catheters for 90 days

This study lasted 39 months from January 2016 to March 2019, with a total of 236,636 inpatients, including 1,369,226 inpatient days, 57,906 indwelling catheter days, 4.23% CUR, 142 cases of CAUTI occurrence, and 2.45‰ incidence of CAUTI.

This cross-sectional study included data from a survey of registered nurses on demographic and work characteristics; and patient discharge abstracts that included data on the care outcomes of patients. The patient outcome of interest was CAUTI; and unit-level patient data were merged with nurse survey data from the same units. Both nurse and patient data were from January 1, 2019 to February 28, 2019.

Data from 2,044 CAUTI and 1,680 CLABSI assessments were included in the analysis. Items were defined as potential gaps if ≥33% respondents answered Unknown, ≥33% No, or ≥50% No or Unknown or Never, Rarely, Sometimes, or Unknown to questions pertaining to those areas. Review of response frequencies and stratification by respondent role were performed to highlight opportunities for improvement

They estimated that over 90 000 people in the UK had long-term catheters. They found most people were initially catheterized in hospital and that prevalence increased with age. Catheterization was more common in people with neurological disease, and suprapubic catheterization was more common in women

 In a general tertiary hospital in Shenzhen, China, we carried out a QCC activity with the theme of reducing CAUTI from April 2017 to December 2017. Before the QCC, we carried out the routine measures; during the QCC, we implemented usual measures and the countermeasures of QCC, and after the QCC, we performed the routine measures and adhered to the core measures of QCC. The interrupted time series analysis method was used to analyze the changes in the CAUTI incidence during the 3 stages.

Multivariate models were fit to determine the association between nursing leadership and CAUTI. Models were adjusted for age, gender, marital status, baccalaureate degree in nursing, employment status (<30 h/wk or ≥30 h/wk), shift worked, rotating shift, and unit patient case mix index; robust standard errors accounted for the clustering for nurses and patients within units. All analyses were conducted using STATA version 15.0 (StataCorp LLC., College Station, TX) with statistical significance set at P < .05.

Self-reported respondent roles were categorized into nurses; medical providers (physicians, nurse practitioners, physician assistants); nurse assistants/technicians; leadership; infection prevention, quality, or education; administrative staff; and other staff. Questions were identified as potential gaps if 33% or more of respondents answered Unknown, 33% or more answered No, or if 50% or more of respondents answered No or Unknown or Never, Rarely, Sometimes, or Unknown.

Systematic analysis of occurrence of CAUTI among patients who have catheterization.

catheterassociated urinary tract infection (CAUTI) regular monitoring.

Effective nurse leaders create work environments that promote a culture of safety. They ensure Magnet-like environments with highly educated nurses, appropriate staffing, teamwork, and ongoing improvements in the quality of care.3 There is evidence that strong leadership engagement with frontline nurses results in decreased CAUTI,4 which is most likely the result of an environment that allows for nurse-initiated catheter discontinuation orders, and care guidelines for aseptic catheter insertion and maintenance

This data points to a need for champion and leadership involvement, conduct of audits and provision of feedback, as well as provider training and competency, in device-related HAI prevention practices. These remain basic and critical components of any infection prevention and control program. 

Community nurses have an important role to play in the diagnosis and treatment of CAUTI, and the well-educated nurse who can differentiate between ASB and CAUTI can reduce the risk of harm to the individual with a catheter and help reduce the growing problem of antibiotic resistance.

 Before, during, and after the QCC activities, the catheter use ratios and mean indwelling time both had a downward trend; meanwhile, the compliance rate of CAUTI prevention measures showed an upward trend. After the interventions, the CAUTI incidence decreased by 1.317‰ immediately, then gradually decreased by 0.510‰ per month. After the completion of QCC, the CAUTI incidence increased by 0.266‰ immediately and increased by 0.070‰ over time, but the difference was not statistically significant.

Leaders who support nursing achieve a common goal of providing excellence in patient care. Nursing leadership can facilitate infection prevention and reduce and possibly eliminate CAUTI through nurse-physician teamwork, collaboration, and allowing nurses the autonomy to make important patient care decisions.

Understanding gaps in infection prevention and control is essential for implementing targeted and efficient improvement efforts. Facilities should work to mitigate gaps identified in these areas for successful CAUTI and CLABSI prevention efforts.

As the UK population continues to grow older, and increasing numbers of people with catheters are cared for in the community, the community nurse’s role in the management of urinary catheters and the diagnosis and treatment of complications including CAUTI is growing. Community nurses who have a good understanding of ASB and CAUTI can ensure that CAUTI is promptly diagnosed and treated and that people with ASB are not inadvertently exposed to the hazards of antibiotic therapy.

The CAUTI incidence is reduced through QCC, providing a useful reference for the prevention of CAUTI and the development of medical quality improvement activities.

Explanation of How the Article Supports EBP/Capstone

Focusing on Improving the gaps on CAUTI prevention